Basic Information
Provider Information
NPI: 1790118206
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAPMAN
FirstName: KRISTIN
MiddleName: L
NamePrefix: MRS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 800 PRUDENTIAL DR
Address2: TOWER B, 11TH FLOOR
City: JACKSONVILLE
State: FL
PostalCode: 322078202
CountryCode: US
TelephoneNumber: 9043886518
FaxNumber: 9043841005
Practice Location
Address1: 800 PRUDENTIAL DR
Address2: TOWER B, 11TH FLOOR
City: JACKSONVILLE
State: FL
PostalCode: 322078202
CountryCode: US
TelephoneNumber: 9043886518
FaxNumber: 9043841005
Other Information
ProviderEnumerationDate: 08/20/2013
LastUpdateDate: 06/08/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XARNP9218608FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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